Psycho-Babble Medication Thread 994620

In reply to Re: 40% down to 25% » morgan miller, posted by floatingbridge on September 19, 2011, at 20:56:36

Hey FB, I don't think methylene blue is going to be a problem at a 60 to 100 microgram dose when mixed with SSRIs or other serotonergic antidepressants. It's definitely worth trying for those of us who are more stabilized but still suffering cognitive and energy issues.

In reply to Re: 40% down to 25% » SLS, posted by floatingbridge on September 20, 2011, at 15:44:15

> Scott, I hope the wash is going alright today. Thinking of you.

Thanks, FB.

My depression is somewhat worse, but tolerable. I am still experiencing sensations in my head that remind me of the brain-zaps seen with SRI withdrawal. My appetite has decreased dramatically, and I have lost 7 pounds. Only 50 pounds more to go.

In reply to Re: 40% down to 25% » floatingbridge, posted by SLS on September 20, 2011, at 16:27:42

> > Scott, I hope the wash is going alright today. Thinking of you.> > Thanks, FB.> > My depression is somewhat worse, but tolerable. I am still experiencing sensations in my head that remind me of the brain-zaps seen with SRI withdrawal. My appetite has decreased dramatically, and I have lost 7 pounds. Only 50 pounds more to go.> > > - Scott

This is weight that you gained after starting nardil that you are losing now?

In reply to Re: 40% down to 25% » SLS, posted by Conundrum on September 21, 2011, at 13:40:19

> > > Scott, I hope the wash is going alright today. Thinking of you.> > > > Thanks, FB.> > > > My depression is somewhat worse, but tolerable. I am still experiencing sensations in my head that remind me of the brain-zaps seen with SRI withdrawal. My appetite has decreased dramatically, and I have lost 7 pounds. Only 50 pounds more to go.> > > > > > - Scott> > This is weight that you gained after starting nardil that you are losing now?

Actually, most of the weight was gained over a period of three years while taking Abilify. The addition of Nardil made my weight jump another 17 pounds over the course of a few weeks. I had been 157 lbs or so before Abilify. I looked pretty good. I was as heavy as 227 lbs with Abilify and Nardil. I looked pretty disgusting. Now, I look just short of being pretty disgusting. I'm about 210 lbs.

In reply to Re: 40% down to 25% » Conundrum, posted by SLS on September 21, 2011, at 15:00:08

In another post, you mentioned a good question:

Since both Viibryd and Abilify are partial 5HT1A agonists, how would this affect receptor occupancy?

Have you found the answer to this question?

Wikipedia reports the following:

Vilazodone, 5HT1a :IC50 = 0.5 nM; IA = ~60-70%

Aripiprazole, 5HT1a:Ki = 1.65 nM

I am more familiar with the units used in the Aripiprazole document and don't know what IC50 stands for. Did you ever answer this question yourself? I am curious. If the units were the same, wouldn't a lower Ki value mean higher affinity?

In reply to Re: 40% down to 25% » Conundrum, posted by SLS on September 21, 2011, at 15:00:08

> > > > Scott, I hope the wash is going alright today. Thinking of you.> > > > > > Thanks, FB.> > > > > > My depression is somewhat worse, but tolerable. I am still experiencing sensations in my head that remind me of the brain-zaps seen with SRI withdrawal. My appetite has decreased dramatically, and I have lost 7 pounds. Only 50 pounds more to go.> > > > > > > > > - Scott> > > > This is weight that you gained after starting nardil that you are losing now?> > > Actually, most of the weight was gained over a period of three years while taking Abilify. The addition of Nardil made my weight jump another 17 pounds over the course of a few weeks. I had been 157 lbs or so before Abilify. I looked pretty good. I was as heavy as 227 lbs with Abilify and Nardil. I looked pretty disgusting. Now, I look just short of being pretty disgusting. I'm about 210 lbs.> > > - Scott> > > > > >

I'm around 223 so I know how you feel. I was around 200 before I tried remeron and then nardil and gained a lot of weight. The thing that sucks about Nardil is it makes me sweat profusely when I exercise so I feel less inclined to be bothered with it.

I need to talk to my pdoc soon, I think the Nardil is making my anhedonia worse not better and I hate wasting my time trialing "fat" pills.

In reply to Re: 40% down to 25% -- Viibryd trial question » SLS, posted by zonked on September 21, 2011, at 22:03:53

> In another post, you mentioned a good question:> > Since both Viibryd and Abilify are partial 5HT1A agonists, how would this affect receptor occupancy?> > Have you found the answer to this question?

No. I think IC50 means the concentration at which 50% of the receptors are occupied and inhibited. The answer to the question is deceptively complicated. I've got a model floating around in my head, but it is difficult to explain briefly. One important question is to what degree these two drugs flip conformations to produce 5-HT1a agonism at a given receptor.

Questions like these are sometimes more esoteric than applicable. I think I would rather try Viibryd in ignorance and without predicting its potential to improve my condition. I might have an easier time suggesting answers to the questions asked once I establish how Viibryd affects me. I might even try removing Abilify if I respond well to the addition of Viibryd. Is D2 partial agonism important to the ability of Abilify to provide improvements in depression? Is 5-HT1a partial agonism sufficient? Remember, the most ubuquitous serotonin receptor in the brain is 5-HT1a. They populate numerous different regions and have different functions. Do Abilify and Viibryd mirror one another in the agonism of 5-HT1a receptor populations? I think Abilify is limited to somato-dendrytic autoreceptors. In addition to these receptors, Viibryd effectively acts upon inhibitory presynaptic autoreceptors and excitatory postsynaptic receptors, with it acting selectively on presynaptic autoreceptors, particularly at low dosages.

In reply to Re: Viibryd » floatingbridge, posted by SLS on September 23, 2011, at 16:20:58

> > Do you start next week? (I track time pretty poorly.....)> > Monday.> > > How is your day going so far?> > Not too bad. I haven't relapsed to my untreated baseline. Perhaps there is an inertia that will allow me to function for a few weeks.>

> > How is your day going so far?> > Not too bad. I haven't relapsed to my untreated baseline. Perhaps there is an inertia that will allow me to function for a few weeks.> > Who knows?> > > - Scott

I saw my (brilliant) doctor today and we usually spend most of the session just talking pharma/neuroscience - especially since I fixed my insurance problem and will maintain on my current regimen. I forgot to ask him what he makes of Viibryd.

We did make a little joke about Oleptra (he said when the drug rep came in to promote it, "we were so mean to them they never came back.") He laughed when I said "the first thing I thought when I heard about Oleptra was, hangover XR."

Anyway, I hope you were able to work something out. This is truly the most novel antidepressant to come to market in a long time.

(Please, Forest. When you launch your DTC campaign, nothing as disturbing as the Pristiq ladies and their wind-up-doll Avatars. Thanks!)

In reply to Re: Viibryd » SLS, posted by zonked on September 23, 2011, at 16:59:54

> I saw my (brilliant) doctor today and we usually spend most of the session just talking pharma/neuroscience - especially since I fixed my insurance problem and will maintain on my current regimen. I forgot to ask him what he makes of Viibryd.

I would be very interested to know what your doctor thinks of Viibryd.

No word back from my insurance company. I will have my doctor's office send another fax on Monday.

In reply to Re: Viibryd » zonked, posted by SLS on September 23, 2011, at 19:53:59

> No word back from my insurance company. I will have my doctor's office send another fax on Monday.

Got it!

I should be up to 40mg by the end of week 2. I am only on day 2. However, I feel it in my brain already. I am slightly improved. I have more energy and can process information faster. These are infrequent occurrences for me. It's just a blip, I guess. I wouldn't expect anything substantial until week 4.

In reply to :-) » Everyone, posted by SLS on September 27, 2011, at 21:37:46

There are advocacy group for most conditions, but none that I am aware of for treatment-resistant depression (unipolar or bipolar.)

Depression robs one of energy, so perhaps that's a reason.

I don't think we are so few in number so as to not warrant an advocacy group of our own. No, NAMI doesn't count.

It's something I've been thinking about off and on. Unfortunately, of the many things I do graphic design and website design aren't among them.

I wonder if having such a group would get any attention (press perhaps?) or pressure pharma to consider us a distinct group to study in trials.

As far as I know, the only drugs with FDA *indications* for TRD are Symbyax (Zyprexa with Prozac) and Marplan.

Just an idea. Maybe if I return to full functioning (including occupational) this is a cause I could devote some time to.

I think if big pharma pursued indications for TRD as well as MDD for novel compound they might sell more product. Having said that, the product would have to be effective for TRD. TRD-ers are often excluded from trials for various reasons (previous suicide attempts, I believe, being one of them.)

In reply to Re: TRD advocacy » zonked, posted by SLS on September 28, 2011, at 5:55:06

> Hi Z.> > You offer very cogent arguments for greater recognition of TRD.> > > I don't think we are so few in number so as to not warrant an advocacy group of our own. No, NAMI doesn't count.> > Why not?NAMI *seems* to be focused more on other mental disorders perceived as more chronic and disabling.Also, I don't have time to look at it now; someone once told me they had accepted donations from pharmaceutical companies. I can't say that's blanket good or bad...

Good for support groups, but I was thinking more along the lines of, like, how The American Cancer Society is for Cancer.

> I didn't know that Marplan was indicated for TRD.

If you look at the advertising on their website, it's for "treatment resistant depression." US rules only allow advertising for approved indications. I think this supplemental indication is why it was brought back from the dead after Roche didn't seem to care that it pre-dated DESI and never bothered to implement it; and why the third party (Validus?) was interested in it.

> It is wonderful that you now have the resources to consider and act upon such issues.> > Stay well.> > > - Scott

Scott, be patient, and your brain will feel like you remember again. Me, telling you to be patient, that's rich. Some of my own patience has been influenced by watching you over the years. I should say, one day you will feel like yourself - consistently - again. And you have the writing skills to write a novel about your experiences should you ever wish to.

I hope it's Viibryd that does the trick for you. BTW, how easily is the Nardil weight coming off? I am not going to mess with my regime, just curious.